Planning for the worst

Susan Halpern wasn't born when her grandmother learned she had breast cancer. And she was barely a teenager when doctors found the disease in her mother.

For 15 years, she watched the disease end her parents' marriage, sap her mother's savings.

In 1987, it killed her mother.

With this lineage, Halpern believed the odds were good that she would one day hear the same diagnosis.

Susan Halpern wasn't born when her grandmother learned she had breast cancer. And she was barely a teenager when doctors found the disease in her mother.

For 15 years, she watched the disease end her parents' marriage, sap her mother's savings.

In 1987, it killed her mother.

With this lineage, Halpern believed the odds were good that she would one day hear the same diagnosis.

So she spent two decades preparing for the disease -- physically, mentally and financially -- while remaining hopeful it might pass her by.

"I wasn't afraid of dying from it; I was afraid of living with it," said Halpern, 47. "Women can live for 15 years. It can bankrupt you."

So she made sure her South Side home was paid off. The cars she drives cost $300 and $200, and her live-in boyfriend, David Hout, a mechanic, keeps them running.

She said no to luxuries such as concert tickets, stayed debt-free and put savings into individual retirement accounts and CDs.

She always had health insurance. Self-employed most of her life, she bought a policy on the open market.

Then, during a May 2006 exam, Halpern's gynecologist felt a lump in her left breast that regular mammograms had missed.

Financial worries

Halpern didn't want to wait for the appointment with her surgeon after the biopsy and pushed Dr. Linda Han to give her the news over the phone.

Han told her she had invasive ductal carcinoma, the most-common form of breast cancer.

Halpern was worried about her job and the house she and Hout were buying to rehab together.

And she worried about her health insurance, which requires that she spend $10,000 out of pocket each year before all her medical costs are covered.

To save money, Halpern underwent two surgeries at the same time. Most patients would have scheduled them months apart.

After Han removed both breasts, a plastic surgeon stepped up to the operating table and put implants into her chest to stretch and grow skin for future reconstructive surgery.

Doing this saved Halpern from two sets of hospital bills. Despite the savings, the money she saved for two decades was disappearing.

Health on a budget

In spite of the financial blows, Halpern was in better shape than many other patients.

"I do not hear of many folks looking at the inevitability of a health-care crisis," said Kathleen Stoll, director of health policy for the health advocacy group Families USA. "She's fairly unusual."

Halpern said she has to weigh every medical decision with finances in mind.

For example, she never considered a lumpectomy: too many chances for cancer to return, as it had in her mother.

"I can't afford to have breasts," she said. "I can't afford it physically or financially."

She'd marry Hout if it meant more affordable health insurance, but his employer doesn't cover spouses.

She's a vegetarian who tries to eat organic foods but can't afford the more expensive produce. She revived her vegetable garden this year to save money.

She takes advantage of free food and services for cancer patients and survivors -- herb plants from a local nursery and yoga classes.

And Halpern reads medical studies, especially those about eating right and exercising to reduce health-care costs. She is among the 5 percent of Ohioans who buy individual health-insurance policies. She pays $600 a month in premiums.

While it's difficult to calculate the total expense of an illness such as breast cancer, Han estimates that surgery, chemotherapy or radiation can cost $110,000.

Halpern used a credit card to pay her medical bills last year and cashed in some of her CDs to pay off the debt.

She plans to do the same thing this year with what's left of her savings.

"I have no retirement," said Halpern, executive director of the Columbus International Film and Video Festival, a small nonprofit. She makes about $19,000 a year.

"I'm 47 and starting over."

Helping others

Julie Kauffman and Angela Rogers, who live across the street from Halpern, say their neighbor remained strong through a tough year.

"A person who's kind of fragile would have fallen apart," Kauffman said. "She was very calm and very cautious."

Her friend, Joe Somrak, said Halpern looks out for other people's health as well.

For example, when he was told several years ago that his cholesterol was high, she taught him how to eat healthfully.

"I didn't have to go on Lipitor because of her," he said. "She really changed my diet."

Her illness has had a positive effect on Hout and how he handles money.

He used to use extra cash to buy and fix up cars and motorcycles. During her chemo, he sold his motorcycle to help pay for her prescriptions and has saved some money.

"The fact that there's money in my bank account is a new and exciting thing," he said.

Living with illness

Halpern scheduled two surgeries this year so she won't have to come up with $10,000 next year.

Last week, a surgeon removed her uterus and ovaries because of endometriosis, a condition that can cause severe abdominal pain and bleeding. The surgery also calmed her fears about ovarian cancer.

She scheduled reconstructive breast surgery for November.

Halpern said she's nervous every step of the way.

At the end of the year, most of her savings will be gone.

"I spent 20 years with the understanding that this could happen," she said. "It's not just the disease; it's trying to afford it."

Despite her financial fears, Halpern said she will live every day as she has since becoming a patient -- looking out for her health as well as her wallet.

shoholik@dispatch.com

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